MEDICARE: TIMOTHY J DENIS R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03-2-23553	OH

General Provider Information

NPI Number	:	1326208836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY J DENIS R.PH.

Provider Business Mailing Address
First Line	:	88 RAMBLESIDE DR
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44907-2028
Country	:	US
Telephone Number	:	419-565-0857
Fax Number	:

Provider Business Practice Location Address
First Line	:	2205 WALKER LAKE RD
Second Line	:
City	:	ONTARIO
State	:	OH
Zip	:	44903-6519
Country	:	US
Telephone Number	:	419-747-1450
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2008
Last Update Date	:	06/21/2011

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